Acta Obstetricia et Gynecologica Scandinavica

Introduction. The relation of migration to infant outcomes is unclear. There are studies which show that some migrant groups have similar or even better outcomes than those from the receiving country. Equally, raised risk of adverse outcomes for other migrant groups has been reported. Objective. We sought to determine (1) if migrants in western industrialized countries have consistently higher risks of stillbirth, neonatal mortality, or infant mortality, (2) if there are migrant sub‐groups at potentially higher risk, and (3) what might be the explanations for any risk differences found. Design and Setting. Systematic review of the literature on perinatal health outcomes among migrants in western industrialized countries. Methods and Main outcome measures. Drawing on a larger systematic review of perinatal outcomes and migration, we reviewed studies including mortality outcomes (stillbirths and infant deaths). Results. Eligible studies gave conflicting results. Half (53%) reported worse mortality outcomes, one third (35%) reported no differences and a few (13%) reported better outcomes for births to migrants compared to the receiving country population. Refugees were the most vulnerable group. For non‐refugees, non‐European migrants in Europe and foreign‐born blacks in the United States had the highest excess mortality. In general, adjustment of background factors did not explain the increased mortality rate among migrants. Regarding causes of death, higher preterm birth rates explained the increased mortality figures among some migrant groups. The increased mortality from congenital anomalies may be related to restricted access to screening, but also to differing attitudes to screening and termination of pregnancy. Conclusions. Mortality risk among babies born to migrants is not consistently higher, but appears to be greatest among refugees, non‐European migrants to Europe, and foreign‐born blacks in the US. To understand this variation better, more information is needed about migrant background, such as length of time in receiving country and receiving country language fluency. Additional data on demographic, health care, biological, medical, and socioeconomic risk factors should be gathered and analyzed in greater detail.

Background. The population of gynecological cancer survivors is growing, yet little is known about the effects of cancer and treatment on pain and quality of life well beyond the completion of therapy. The aims of this study were to investigate quality of life and the prevalence, intensity and presentation of pain in long‐term survivors of gynecological cancer compared to a representative group of women from the general population. Methods. The study comprised women aged 32–75, residing in a central part of Norway. Cases were gynecological cancer survivors treated at University Hospital, Trondheim, Norway, between 1987 and 1996, and age‐matched women selected at random from the general population served as controls. After 1 reminder, the response rate was 55% (176/319) and 41% (521/1,276) for survivors and controls, respectively. A total of 160 gynecological cancer survivors and 493 controls were eligible for final analyses. Pain was measured by the item ‘How often do you have pain?’ and marks on a body chart indicating pain sites. Ferrans and Powers’ Quality of Life Index (QLI) measured quality of life. The level of statistical significance was set at p≤0.05. A φ² test for categorical variables, unpaired t‐test for continuous variables, and logistic regression were applied. Results. On average, the long‐term gynecological cancer survivors had a complete recurrence‐free period of 12 years (range: 7–18). The prevalence of pain was 26%. The results revealed no difference in the prevalence of pain between women who survived gynecological cancer and women without a gynecological cancer history. Women suffering from musculoskeletal disorders or living in households with low income are more likely to suffer pain. The small group of women with a previous history of gynecological cancer and living in a low income household experience more pain, particular if they suffer from edema. Pain shows a clear negative effect on quality of life, especially on the health and functioning domain. There was no difference in the quality of life between cancer survivors and controls. Conclusion. Long‐term gynecological cancer survivors do not differ from other women in terms of pain and quality of life. Pain is associated with musculoskeletal disorders and low income.

Objective.  We verified whether a misdiagnosis of gestational diabetes mellitus can result in pregnant women when glucose tolerance has deteriorated after a low‐carbohydrate meal, and tried to elucidate the mechanism behind the different outcome of the test.

Study design.  Twenty‐seven pregnant women were given directions for their evening meal the day before each of two 75‐g oral glucose tolerance tests (OGTT). The evening meal was either a low‐carbohydrate meal (carbohydrate, 6.7%; Low), or a high‐carbohydrate meal (carbohydrate, 85.7%; High).

Results.  The OGTT showed that the glucose tolerance was significantly impaired after Low than after High, with a significant increase of fasting plasma non‐esterified fatty acids (NEFA) level. Moreover, the insulinogenic index (I‐I) after High significantly decreased than that after Low.

Conclusions.  The present data suggests that there is a risk of misdiagnosis of impaired glucose tolerance with only one intake of this extremely low‐carbohydrate meal on the evening before testing. The decrease of insulin secretion and the activation of glucose‐fatty acid cycle may be considered as the mechanism.

Background. Fetal growth may be determined by genetic as well as environmental factors. Whether psychological distress during pregnancy influences fetal growth is a matter of debate.

Material and methods. A prospective population‐based study with repeated measures of psychological distress (General Health Questionnaire) during pregnancy, based on the use of questionnaires. Danish speaking women with singleton pregnancies attending antenatal care between August 1, 1989 and September 30, 1991 were eligible to the study (n = 8719). Of these women 5868 women (67%) completed all questionnaires. The main outcome measure was fetal growth (assessed as birth weight for gestational age (continuous)) and birth weight below the 10th percentile of birth weight for gestational age (light for gestational age (LGA) (dichotonmus). Gestational age was calculated primarily from an early ultrasound scan. Confounders were controlled using multivariate statistical methods.

Results. Birth weight for gestational age and risk of delivering a LGA baby were not associated with psychological distress, neither distress in 16th week nor in 30th week of pregnancy.

Conclusion. To the extent that fetal growth can be explored at birth, the results indicate that psychological distress does not influence fetal growth.

Abstract. Dehydroepiandrosterone sulfate (DHAS) is now used for a dynamic test of placental function by many obstetricians. While practicing this test, the authors found that DHAS markedly promoted so‐called “cervical ripening”. To study this problem, DHAS of 50 or 100 mg in multiple doses were injected into 132 Japanese pregnant women in their 38th–42nd week of gestation. The change in Bishop score was carefully recorded. Bishop score in the injected groups of primiparae (100 mg) began to rise much sooner than the control groups (p<0.01 on seventh day and 14th day). However, such significant difference in the rise of Bishop score was not noted in the multiparae and primiparae with 50 mg. Although the rise of score is not significant, the duration (day) from injection to delivery was shorter in the injected group than the control group (t=2.1529, p<0.05 in primiparae with 50 mg, t=3.8829, p<0.01 with 100 mg, t=2.1029, p<0.05 in multiparae with 50 mg). In some of these cases, labor began or delivery was finished within 24 hrs. Among the factors of Bishop score, mainly the effacement, consistency and dilatation of the cervix were remarkably improved by DHAS injection (p<0.01 and <0.05). Side effects of any type were not seen in the mothers and foetuses. As a conclusion, DHAS injection is considered to produce favorable conditions for delivery in women with “unripe cervix” by softening the soft birth canal. Furthermore, it is suggested that DHAS might play an important role in triggering labor.

We compared short‐term surgical outcomes of laparoscopic and ultraminilaparotomic procedures for the treatment of large uterine myomas in a retrospective matched‐control study (Canadian Task Force classification II‐2) of 32 women with large myomas who underwent laparoscopic myomectomy and 32 women who had ultraminilaparotomic myomectomy (≤4 cm incision). Myomectomies were successfully performed for all women in both groups, but time to discharge was significantly lower after laparoscopic than after ultraminilaparotomic myomectomy (p = 0.01). Laparoscopic myomectomy seems to be the preferable approach for the treatment of large myomas of ≥5 cm, providing a more rapid recovery compared to the ultraminilaparotomic approach. Ultraminilaparotomy may be a valid alternative in case of laparoconversion instead of the classic laparotomy approach.

Background. All cases of obstetric hysterectomies that were performed in our hospital during a seven‐year study period were reviewed in order to evaluate the incidence, indications, risk factors, and complications associated with emergency obstetric hysterectomy. Methods. Medical records of 45 patients who had undergone emergency hysterectomy were scrutinized and evaluated retrospectively. Maternal age, parity, gestational age, indication for hysterectomy, the type of operation performed, estimated blood loss, amount of blood transfused, complications, and hospitalization period were noted and evaluated. The main outcome measures were the factors associated with obstetric hysterectomy as well as the indications for the procedure. Results. During the study period there were 32,338 deliveries and 9,601 of them (29.7%) were by cesarean section. In this period, 45 emergency hysterectomies were performed, with an incidence of 1 in 2,526 vaginal deliveries and 1 in 267 cesarean sections. All of them were due to massive postpartum hemorrhage. The most common underlying pathologies was placenta accreta (51.1%) and placenta previa (26.7%). There was no maternal mortality. Conclusions. Obstetric hysterectomy is a necessary life‐saving procedure. Abnormal placentation is the leading cause of emergency hysterectomy when obstetric practice is characterized by a high cesarean section rate. Therefore, every attempt should be made to reduce the cesarean section rate by performing this procedure only for valid clinical indications.